TATRC TIMES · the work, and we need your partnership more than ever.” BG Talley specifi cally appreciated the vast cross-lab, academia, and industry partnerships and relationships

July 2020 • Volume 6, Qtr. 1July 2020 •TATRCTATRC TIMESTIMES

A QUARTERLY PUBLICATION OF THE TELEMEDICINE & ADVANCED TECHNOLOGY RESEARCH CENTER

IN THIS ISSUE:MRDC COMMANDER MAKES A DOUBLE VISIT TO TATRC .................................1TEAM TATRC GATHERS FOR STRATEGIC PLANNING OFFSITE – BIG IDEAS YIELD BIG RESULTS FOR ORGANIZATION .................2SENIOR OUSD SES MEMBER VISITS TATRC FOR ‘TECH TALK ..................................4BHSAI LICENSES THE 2B-ALERT FATIGUE-MANAGEMENT AI TOOL FOR COMMERCIAL DEVELOPMENT .......................5NO PILOT, NO PROBLEM: UNMANNED “FLYING” LABORATORY LIFTS OFF IN A TATRC FIRST .....6TATRC VISITS IBM’S THOMAS J. WATSON RESEARCH CENTER .......................................7TATRC HQ HEADS SOUTH TO FORT GORDON ....8TEAM MHIC TAKES TO THE LINKS FOR CHARITY ......................................8MHIC ANNOUNCES ITS EMPLOYEE OF THE QUARTER FOR THE FT. GORDON TEAM ............9TATRC’S MHIC TEAM COLLABORATES AT CLEMSON UNIVERSITY ..................................9TATRC VISITS UK’S MINISTRY OF DEFENSE TO ESTABLISH A COLLABORATIVE RESEARCH PARTNERSHIP ...........................10“DIRECTOR’S TOWN HALL FOCUSES ON NEW LAB SPACE AND ‘RALLIES THE TROOPS’ FOR THE YEAR AHEAD!” ...............................11TATRC’S MOBILE HEALTH PROJECT ‘FOXTROT’ TROTS INTO THE SPOTLIGHT ........12NATIONAL GUARD ANNOUNCES PROOF-OF-CONCEPT PILOT OF TATRC READINESS APP ..........................................13EMPLOYEE SPOTLIGHT: CONGRATULATIONS TO MISL’S REBECCA LEE ON EMPLOYEE OF THE QUARTER! .......................................14EMPLOYEE SPOTLIGHT: NEW PROJECT OFFICER TO JOIN TATRC’S MEDICAL MODELING AND SIMULATION TEAM ..............15BHSAI USES SIMULATIONS TO IDENTIFY THE MOLECULAR BASIS OF ANTIBODY NEUTRALIZATION IN DENGUE VIRUS ............16MAST VIRTUAL HEALTH FY20 UPDATE ..........17JOINT MEDICAL SIMULATION INSTRUCTIONAL METHODS (JMEDSIM) PORTAL .....................................18ANOTHER YEAR OF HOLIDAY CHEER .............19AMTI PROJECT SPOTLIGHT:AMTI SHINES A SPOTLIGHT ON WARFIGHTER PERFORMANCE .......................20 AMTI PROJECT SPOTLIGHT: VIRTUAL REALITY TRAUMA SIMULATION: AN IMMERSIVE METHOD TO ENHANCE MILITARY MEDICAL PERSONAL TRAINING AND READINESS .........22

MRDC Commander Makes a Double Visit to TATRC

TATRC had the opportunity to welcome our newest Commanding General of

USAMRDC, Brigadier General Michael Talley to two back-to-back visits last Fall

for a site visit, portfolio review, and a deep-dive discussion on the potential timeline for

enabling the Army’s transition to Autonomous Combat Casualty Care (ACCC). BG

Talley is making his way around the command and learning about all of the diff erent

units and components that fall under MRDC. Team TATRC was pleased to host BG

Talley for his incoming orientation brief of the organization.

TATRC Director, COL Jeremy Pamplin, kicked off the 2 day visit and briefi ng

with a TATRC Overview and introductions of TATRC’s respective Lab Leads.

mHIC Deputy Lab Lead, Mr. Ron Yeaw, joined by Dr. Robert Walker of the Surgeon

General’s Offi ce of Innovation, followed with a deep-dive presentation and explanation

on the “Capability and Timeline for Enabling the Transition to Autonomous Combat

Casualty Care.”

Dr. Robert Walker stated, “TATRC’s far forward views of what it will take to bring

true autonomous medicine to the battlefi eld resonated very strongly about both this

year’s Defense Health IT Symposium (DHITS ) and the Special Operations Medical

Association (SOMA) conference. I’m glad BG Talley had the opportunity to hear them

as well.” BG Talley echoed this feeling, inviting COL Pamplin to provide the same brief

Mr. Geoff Miller (right) briefs and presents to Brigadier General Michael Talley (center) the plans for TATRC’s new Technology Comparative Eff ectiveness Lab, as COL Jeremy Pamplin and Dr. Robert Walker look on.

MRDC Commander visit continued to page 3

https://mrdc.amedd.army.mil/

http://www.tatrc.org/

A QUARTERLY PUBLICATION OF THE TELEMEDICINE & ADVANCED TECHNOLOGY RESEARCH CENTERA QUARTERLY PUBLICATION OF THE TELEMEDICINE & ADVANCED TECHNOLOGY RESEARCH CENTER

TATRC TIMES

2

July 2020 • Volume 6, Qtr. 1

As an organization, we do not get the opportunity for the

entirety of our team to gather in-person nearly enough!

Luckily, we were able to do just that last November when

the team came together for our inaugural all-hands strategic

planning meeting to discuss the state of our current aff airs,

our organizational mission, strategic messaging, restructuring

and reorganizing, as well as important aspects regarding the

future of TATRC.

Held off site at the Morningside Inn in Frederick, MD, the

interactive all day event provided an excellent opportunity for

the entire team to come together and brainstorm on all things

TATRC, including our focus, our vision, and how best to spread

the message of who we are and what we do. Additionally, the

event provided the perfect opportunity to debut our newly

updated Mission statement – “Forging the future by fusing data,

humans, and machines into solutions that optimize Warfi ghter

performance and casualty care.”

TATRC’s Leadership team, including Director, COL

Jeremy Pamplin, and Deputy Director, LTC (P) Justin Stewart,

presided and got things started with kickoff presentations

on organizational business and an introduction to the overall

purpose of the meeting, which was to begin the process of

developing the TATRC brand and determining how best to

position ourselves as an organization to support and advance

Military Medicine.

COL Jeremy Pamplin set the stage for the team by

stating, “Th e world as we know it is changing. Specifi cally, the

world related to military medicine. One of the issues facing us

is distance. Prolonged fi eld care is something we must grow our

capabilities for. How do we go from the space where we have a

lot of stuff , capability, and resources, to the space where we don’t

have those things? Where our Warfi ghters don’t have those things.

It’s us. It’s technology. It’s TATRC.”

Th e team then broke out into individual work groups and

worked together to solve interactive, hands-on tasks to develop

key aspects of the TATRC mission, including the nature of

the relationship between TATRC, the Warfi ghter, and medical

providers, as well as ways to optimize performance within the

organization by addressing things like management structure and

the dynamics between our various labs and programs. Th ese work

groups proved to be highly productive, with each team creating

unique components that will ultimately be combined and help to

build and refi ne the new mission of TATRC.

Following the work group sessions, the team was treated

to a comprehensive, informative presentation on the various

types of management structures by our very own Ms. Tabitha

Waldrop, MS, PMP, PMI-ACP and Telehealth / Virtual Health

Project Manager from our mHIC offi ce at Ft. Gordon! Ms.

Waldrop expertly guided the team through the various styles of

management and the pros and cons of each, following up with

tasking the groups to determine which style they thought best

suited TATRC. Th is resulted in thoughtful, productive discussions

TEAM TATRC Gathers for Strategic Planning Off site – Big Ideas Yield Big Results for Organization

Team TATRC gathers for rare cross-lab photo op during the Strategic Planning.

Strategic Planning continued to page 3


TATRC TIMESJuly 2020 • Volume 6, Qtr. 1

3

to the MRDC Leadership Conference

being held the following month with the

entire command.

TATRC’s Lab Lead for Medical

Modeling, Simulation, and Visualization,

Mr. Geoff Miller, provided Dr. Walker

and BG Talley a walkthrough of

TATRC’s developing SIM Environment,

the Battlefi eld Emergent Stabilization

Skills Lab, as well as future plans for

TATRC’s Technology Comparative

Eff ectiveness Lab. Mr. Miller was eager

and pleased to explain what these unique

features and new future capabilities will

allow. “TATRC’s ability to develop a true

Human Performance Capability Lab will

truly redefi ne what the fi eld of human

performance means to many people, and I

was glad to see BG Talley’s interest in this

new area,” said TATRC Director, COL

Jeremy Pamplin.

Discussions with BG Talley also

included viewing TATRC’s capabilities

related to Virtual Health, Vertical Lift,

and Artifi cial Intelligence-based Medical

Assist tools. BG Talley was very pleased

with all he saw, telling the TATRC Team

to “Keep doing what you are doing, I love

the work, and we need your partnership

more than ever.” BG Talley specifi cally

appreciated the vast cross-lab, academia,

and industry partnerships and relationships

that TATRC has fostered to help ensure

our portfolios continue to keep up with

the pulse of technology across both the

MRDC Commander visit continued from page 1

Strategic Planning continued from page 2

military and commercial spaces.

TEAM TATRC Th anks BG Talley

for spending some of his valuable time

gaining a deeper understanding of the

important work we do!

across the spectrum of team members,

including Leadership, Lab Leads, as well as

support staff , which could only have been

possible at an event such as this.

Staff member Mr. Ray Samonte,

Graphic Designer and Webmaster who

works on the Public Aff airs team stated,

“It really is empowering for someone who

is not a scientist, like me, to have a voice

and be a part of an organization where

the leadership team is bringing all of us

together to have a voice in forging a future

vision together. It allows those of us even

in support roles to truly feel like we’re a

part of the incredible mission TATRC has

moving forward.”

Ms. Dawn Petruzzello who serves

as the service contract manager on the

Resource Management team was able

to get a deeper look into what goes on

in each individual lab on the day to

day. Ms. Petruzzello said, “To be out of

my comfort zone, in workgroups that

included scientists, technology experts, and

program managers that I don’t normally

work with, really allowed me to have a

better understanding of the organization

as a whole. It opened up a whole other

perspective for me and enhanced my

understanding and appreciation of

everybody’s role here, and how each person

has a vital role to play.”

At the end of the day, the event had

proved to be a resounding success! Perhaps

most importantly, with the exception of

a dearly missed few, the meeting allowed

for all of the team’s voices to be heard

in person and in a meaningful way

– something that is not always easily

achieved due to personnel locations and

day-to-day tasks.

LTC (P) Justin Stewart concluded

the off -site meeting with the following

sentiments, “Th e future fi ght requires

diff erent ways of thinking. We need to

understand what threats our Warfi ghters

are facing and how to address them.

Th is is the beginning of rebranding and

defi ning our role in that fi ght. Th ere is a

lot of hard work ahead, but I think we’re

up for the challenge.”

A big thank you to all our staff

for your dedicated eff orts in helping to

refi ne and improve the TATRC brand!

We are excited to see what TATRC’s

future holds.

BG Talley was very pleased with all he saw, telling the TATRC Team to “Keep doing what you are doing, I love the work, and we need your partnership more than ever.”


TATRC TIMES July 2020 • Volume 6, Qtr. 1

4

Dr. Petro provided TATRC a valuable, high-level awareness briefi ng of programs and priorities at the senior-most areas of DoD, and how they see TATRC’s role in it.

Senior OUSD SES Member Visits TATRC for ‘Tech Talk

TATRC Leadership. COL Jeremy Pamplin (left) and LTC(P) Justin Stewart (right) welcomed Dr. James “Ben” Petro (center), Director of Human Systems, within the Offi ce of the Under Secretary of Defense for Research and Engineering.

On 17 December, TATRC was

fortunate enough to host a

visit and spend the morning with

Dr. James “Ben” Petro, Director of

Human Systems, within the Offi ce of

the Under Secretary of Defense for

Research and Engineering, where he

oversees, coordinates, integrates and

synchronizes a $3.2 B / yr research

portfolio targeted to optimize

Warfi ghter eff ectiveness and lethality.

His management of the Human

Systems portfolio includes the

technology areas of biology (to include

medical, warfi ghter performance, and

nonmedical research), human-machine

teaming, training, environmental

sciences, and DoD compliance with

statutes, regulations, and policies

for protection of human and animal

research subjects, so visiting TATRC

was a logical fi t.

TATRC’s Director, COL Jeremy

Pamplin kicked things off with a

comprehensive overview of TATRC’s

new mission, our approach to research,

and an inside look at the future of

our Medical Robotics, Autonomous

Systems, Virtual Health, and Medical

Simulation portfolios. COL Pamplin

was followed by several key staff from

the Medical Intelligent Systems Lab,

the Mobile Health Innovation Center,

and the Medical Modeling, Simulation

and Visualization Lab.

Dr. Petro provided TATRC a

valuable, high-level awareness briefi ng

of programs and priorities at the

senior-most areas of DoD, and how

they see TATRC’s role in it. Dr. Petro

stated that he was “pleased with how

well TATRC’s portfolio aligned with

future military medicine research

priorities and Army Future Command

initiatives.”

A member of the Senior Executive

Service, Dr. Petro has a Ph.D. in

Microbiology and Immunology from

Vanderbilt University, a Master of

Science in Strategic Intelligence from the

National Defense Intelligence College,

a Bachelor of Science in Biotechnology

from Worcester Polytechnic Institute,

and is a graduate of the Federal Executive

Institute’s Leadership for a Democratic

Society and the Massachusetts Institute of

Technology’s Seminar XXI programs.

TATRC appreciated hosting this

visit from such a champion of innovation.

Th ank you, Dr. Petro for your time!


TATRC TIMES

5


If you’ve been reading the TATRC Times for some time now,

chances are you have heard of Dr. Jaques Reifman, Director

of the Biotechnology High Performance Computing Software

Applications Institute (BHSAI) here at TATRC. Dr. Reifman is

once again making big waves with the licensing of his 2B-Alert

fatigue-management AI tool.

Sleep deprivation is a universal challenge faced by nearly all

Service Members, especially during military operations. It can

lead to accidents and catastrophic mission failures. Th e ability to

predict future alertness levels and recommend eff ective measures

to improve cognitive performance can reduce or prevent accidents

and injury.

Over the past 10 years, Dr. Reifman and his team of BHSAI

researchers synthesized data from decades of sleep research

collected by collaborators at the Walter Reed Army Institute of

Research (WRAIR) and developed a biomathematical model that

predicts how various sleep-deprivation conditions aff ect alertness.

Recently, they integrated the model with an AI algorithm that

learns how each individual responds to sleep deprivation and

generates customized alertness predictions, as well as an algorithm

that quickly discovers the best countermeasures to reduce

alertness impairments at the desired times and durations.

In collaboration with WRAIR scientists, the BHSAI team

has implemented the model and algorithms in two decision tools.

Th e fi rst, 2B-Alert Web, is a PC-based application that allows

users, especially mission planners and work schedulers, to predict

how sleep-wake schedules and alertness-improving measures

aff ect cognitive performance for a group of individuals. Th e

second, 2B-Alert App, is a smartphone AI application that allows

individual users to monitor their own alertness levels and generate

personalized alertness-enhancing recommendations based on

their prior sleep-wake schedules.

Having established a mature 2B-Alert technology, the next

step was to license it. To do so, the BHSAI team worked directly

with the Medical Technology Transfer (MTT) offi ce, which is

USAMRDC’s enterprise-wide Technology Transfer Offi ce led

by Dr. Paul Michaels. MTT identifi es intellectual property that

has the potential for licensing to industry, performs outreach

to potential licensees and Research & Development (R&D)

collaborators, and negotiates the licenses for USAMRDC’s

patents and other intellectual property.

C. Blake Sajonia, the MTT agent assigned to license

the 2B-Alert tool, worked directly with Dr. Reifman and Mr.

Quinton King, a licensing professional from TechLink (a DoD

Technology Transfer Partnership Intermediary), to develop

and execute a licensing strategy. His challenge was to ensure

that USAMRDC remained the holder of the model and

algorithms while retaining the benefi t of one or more companies

commercializing a software product.

BHSAI Licenses the 2B-Alert Fatigue-Management AI Tool for Commercial Development

Working through several iterations of the Patent License

Agreement (PLA) and the Cooperative Research and

Development Agreement (CRADA) to address business, legal,

and technical issues, Mr. Sajonia achieved a mutually acceptable

pair of agreements by linking the PLA with the CRADA,

through which the company would have access to software

upgrades and subject matter expertise. Th e resulting non-exclusive

PLA and CRADA were executed with Integrated Safety Support,

a company focused on fatigue training, analysis, and management,

as well as solutions that enhance future workforces.

Th ese developments place the 2B-Alert tool at the stage of

technology transfer (T2)–a step that helps realize the full benefi ts

of our nation’s R&D investment in funding federal laboratories

and is thus vital to our economy and national security. “T2

for the Army is important because it encourages and enables

companies to produce commercial products that can benefi t

both the public in civilian applications and be purchased by the

military for use. Such products often result in signifi cant cost

savings to the military because of the broader customer base that

dual-use (civilian and military) products have over purely military

products,” said Dr. Paul Michaels, Director of the MTT offi ce.

“It is gratifying to see the research eff orts of numerous

individuals across many years culminate in a product that will be

useful for both the military and the general public, and which

promises to increase Warfi ghter Readiness on a wide scale,” said

Dr. Reifman, at the prospect of working with Dr. Adam Fletcher,

CEO and Principal Consultant of Integrated Safety Support.

Given the potential of commercial partners to add improvements

and features to new technologies to create value-added products,

the possibilities for a new generation of scientifi cally validated

fatigue-management devices seem limitless.

An example of 2B-Ready’s clear and focused Dashboard.



6

No Pilot, No Problem: Unmanned “Flying” Laboratory Lifts Off in a TATRC First

Team TATRC does it again! On

29 October, the fi rst fl ight and

demonstration of the DP-14 Unmanned

Aerial System (UAS) was successfully

held at the Warren Grove Gunnery

Range in New Jersey. Th e project

originated from TATRC’s Medical

Intelligent Systems Lab and concluded

the fi rst phase of a research collaboration

between TATRC, the U.S. Army

Aeromedical Research Lab (USAARL),

and DPI UAV Systems (DPI). Th is study

was developed under a Joint Program

Committee-6 ( JPC-6) funded research

project entitled, “Emergency Medical

Resupply and En-route Care UAS

Research Platform.”

Th is project seeks to provide a “fl ying

laboratory” designed to enable research

of emerging UAS and autonomous en-

route care systems as a means to augment

traditional medical resupply and casualty

evacuation (CASEVAC) eff orts in austere

environments. During Phase 1, the DP-

14 aircraft was designed, built, and tested,

culminating in this successful “maiden-

fl ight” event performed without the exterior

skins of the aircraft to prove out mechanical

performance and system stability during a

manually controlled fl ight.

During Phase 1, an Environmental

Factors Data Acquisition System (EFDAS)

system was designed and built by

USAARL and used to collect data during

the event, measuring conditions that aff ect

Representatives from DPI, TATRC, USAARL, Joint Program Committee-6, Medical Evacuation Proponency Division, Joint Program Committee-1, and the logistics community participated in DP-14’s fi rst test fl ight.

DP-14’s “maiden-fl ight” event performed without the exterior skins of the aircraft to prove out mechanical performance and system stability during a manually controlled fl ight.

Flying Laboratorycontinued to page 7



7

TATRC visits IBM’s Thomas J. Watson Research CenterThomas J. Watson, an American

Businessman, and for whom the IBM

Th omas J. Watson Research Center is

named after, once said, “To be successful,

you have to have your heart in your

business, and your business in your heart.”

On 26 September, TATRC Director,

COL Jeremy Pamplin and Ms. Jeanette

Little, Lab Lead for TATRC’s Mobile

Health Innovation Center, had an

opportunity to visit the Th omas J. Watson

Research Center. Th e Th omas J. Watson

Research Center is the headquarters

for IBM Research and the center is

comprised of two sites, with its main

laboratory in Yorktown Heights, New

York, and the second with offi ces in

Cambridge, Massachusetts. It is part of

one of the largest research organizations

in the world tackling a variety of issues

across diff erent sectors.

While on campus, they met with Dr.

Jeff Rogers, who leads IBM’s global research

eff orts in using artifi cial intelligence and

internet-of-things or devices for healthcare.

Th e work of Dr. Rogers and his team

focuses on creating systems of integrated

sensors, models, and closed-loop controllers

to support personalized health. He has

overseen the deployment of these systems to

homes, cars, and medical facilities to address

applications ranging from managing chronic

disease to wellness.

One of the things that Dr. Rogers

and his team of researchers are focused

on is leveraging quantum computing to

identify potential clinical conditions based

on biosensor data. Th is approach could

potentially enhance the eff orts already in

During their visit, Ms. Jeanette Little (left) and COL Jeremy Pamplin (right) teamed up against IBM Watson in a friendly game of ‘Jeopardy!’.

progress by TATRC in the operational

environment. COL Pamplin and Ms. Little

were able to tour the ‘Smart House’ on the

research campus, and talk to numerous

individual researchers about their work in

the early detection of Parkinson’s disease

using sensor technologies within the home.

Th ey were also introduced to the work being

done at IBM about sensor data that can

be collected from all areas of life including

vehicles and social media, among other

sources. Th ese expanded technologies could

potentially also impact the research TATRC

has already done. Th ere was also an

opportunity to tour the quantum computer

confi guration lab and discuss possible

options for a future IBM / TATRC

collaborative research project leveraging

artifi cial intelligence and quantum

computing. “Th is visit demonstrates

the importance of the work TATRC is

already undertaking, but it also helps to

build partnerships with respected industry

leaders in the civilian sector which might

help broaden the horizons of our future

work,” COL Pamplin stated.

patient safety during fl ight. During the

next phase, DPI will complete the build

and fl ight testing of the DP-14 UAS,

adding the required vehicle autonomy and

network capabilities, resulting in a UAS

testbed for autonomous medical transport

and evacuation research. Th e fi nal fl ight

demonstration is planned for late next

spring. Attendees included representatives

from DPI, TATRC, USAARL, Joint

Program Committee-6, Medical

Evacuation Proponency Division, Joint

Program Committee-1, and the logistics

community.

Dr. Gary Gilbert of TATRC’s MISL

Lab stated, “By leveraging emerging

technology to develop faster, more

effi cient methods of medical resupply

and CASEVAC, TATRC is ensuring

Warfi ghter resiliency and maintaining

Flying Laboratory continued from page 6

the Army’s competitive advantage over

potential adversaries.” A big shout out to

all involved who made the fi rst fl ight of

this one-of-a-kind aircraft such a success!

Dr. Gary Gilbert and Mr. Nathan Fisher,

of TATRC’s MISL Team look forward

to continued collaborations with this

esteemed group of partners.


TATRC TIMES

8


potluck luncheon that everyone enjoyed.

“Having Leadership here and on

the ground fi rst hand really made a big

diff erence. While we’re all connected and

virtual, having the opportunity to interact

in person to discuss such key things like

mHIC’s specifi c accomplishments and

TATRC HQ Heads South to Fort Gordon

Team mHIC Takes to the Links for Charity

In late October, TATRC’s Senior

Leadership and Command team

conducted a site visit to TATRC’s

mHIC offi ce, located in Fort Gordon,

Georgia. Th is was the fi rst occasion for

TATRC’s new Deputy Director, LTC

(P) Justin Stewart to meet mHIC’s team

members fi rst hand and see the unique

work being done on site at Fort Gordon.

Th e 2 day series of meetings allowed

team members, individually and as small

functional teams, to have quality time

with our leadership to further introduce

themselves, their work, and to familiarize

our leaders with the unique capabilities

our mHIC team contributes to TATRC

as a whole. Team mHIC provided

project status reports and conducted

focused discussions on specifi c research

projects for FY20, allowing for valuable

input and feedback from our Senior

Leadership for future direction and

notional guidance as we plan for projects

beyond FY20. In addition to the packed

and productive meeting agenda, the GA

crew showed off their typical southern

culinary hospitality, with a signature

TATRC Fort Gordon Team with TATRC Leadership.

On Friday, 11 October, mHIC staff members from our

offi ce at Fort Gordon in Augusta, Georgia took to the

links in the name of charity. Mr. Marvin Cole, Mr. TJ Brown,

Ms. Tabitha Waldrop and Mr. Nate Montgomery took time

away from the offi ce to volunteer and participate in the Blake

Hadden Memorial Golf Tournament. Th is local tournament was

established in 2018, in memory of a young native Augusta golfer

whose life ended too soon. Proceeds from the Blake Hadden

Memorial Golf Tournament provide scholarships for athletes

who excel academically and athletically.

Held on a Friday in conjunction with the Southeastern

Junior Golf Tour, a junior golfer was paired with each team of

adults, and the event was considered that junior golfer’s practice

round for their tournament which occurred that weekend. Our

team’s junior golfer was nine-year old Turner Stevenson, who

has already won 49 trophies over the past two years! It was a

great day for fun with an up and coming potential future golf

champion. We’re keeping an eye on his young career!

“It was a great day. An experience I will never forget! And

young Turner is amazing! I can’t wait to see how he’s doing in

about ten years. He’s probably going to be famous!” said Marvin

Cole, one of mHIC’s Systems Integrators.

challenges, as well as future plans at both

the research end of the spectrum, and the

internal organizational capabilities as a

whole, was invaluable,” stated Ms. Jeanette

Little, mHIC Lab director.

Team mHIC looks forward to hosting

our Senior Leadership’s next visit!

Our golf team for the day, left to right: TJ Brown, Turner Stevenson, Nate Montgomery and Marvin Cole.

For more information about the tournament, please visit

www.cricketfoundationbh.com.

www.cricketfoundationbh.com


TATRC TIMES

9


Congratulations are in

order for Mr. Ronnie

“Dean” Parrish of TATRC’s

Mobile Health Innovation

Center located at Fort

Gordon in Augusta, GA.

Mr. Parrish is dual hatted

and serves as a mobile

application and web portal

developer for the MHCE

system, and was specifi cally

recognized this quarter for

his eff orts to develop and

fi eld the beta version of

an ocular trauma mobile

telemedicine application

known as FOXTROT.

Th anks to Dean’s

commitment to excellence,

the deployment of

FOXTROT was immensely

successful, as this capability enabled role 1 - 3 medic-users

to place teleophthalmology consults in the FOXTROT

TATRC’s mHIC Team Collaborates at Clemson University

On 10 October 2019, Ms. Jeanette

Little and Ms. Amanda Schmeltz

from TATRC’s Mobile Health

Innovation Center (mHIC) in Fort

Gordon spent the day at the Clemson

University School of Public Health, in

an extensive working session where they

collaborated with Dr. Ron Gimbel and

his team of researchers to discuss key

fi ndings and results from their latest

research study, and fi nalize details for some upcoming peer reviewed

publications. Dr. Gimbel serves as the chair of the Department

of Public Health Sciences within the College of Behavioral,

Social and Health Sciences. He came to Clemson in 2014 from

the Uniformed Services University of the Health Sciences with

extensive experience in operations, health administration and

health policy. His research interests focus on improving health

care delivery and health outcomes through clinical research on

physician decision-making, clinical documentation, and enhanced

communication. Ms. Amanda Schmeltz stated that, “being on-

site and in this immersive environment with our colleagues at

Clemson allowed us to discuss the implications of this critical

research and vital next steps from the lessons learned.”

In addition, the TATRC team members were able to

visit with Dr. Kuang-Ching “KC” Wang from Clemson’s

Holcombe Department of Electrical and Computer Engineering

Department and discussed his research eff orts on supporting

communications in the DIL (denied, intermittent, or low/

no comms) environment expected in the MDO. Dr. Wang is

currently engaged in research in wireless networks and mobile

computing, ad hoc and sensor networks, distributed protocols, and

pervasive applications and embedded systems, which made this a

natural fi t for the mHIC team.

Th e day proved fruitful and productive as the two teams

fi nalized planning for an article that was submitted into

the Journal of Medical Internet Research following the joint

TATRC / Clemson / Madigan Army Medical Center / Nellis

Air Force Base Diabetic home monitoring project analysis, being

fi nalized as of this writing. Dr. Wang briefed the team on his

progress as Principal Investigator on the “Complete and Resilient

Documentation (CARD) for Operational Medical Environments”

project, as well as capabilities being integrated to further support

Warfi ghter communications in the anticipated diverse range of

challenging networking requirements.

mHIC Announces its Employee of the Quarter for the Ft. Gordon Team

mobile app for trauma or disease non-battle injury (DNBI).

An expeditionary ophthalmologist stationed in Bagram,

Afghanistan was alerted via email and responded using a secure

computer portal directly linked to the mobile app end users. Our

partner and PI on the project, Maj William G. Gensheimer,

MD, reported very high user satisfaction and exceptional

response time following the analysis of this beta testing.

Notably, during initial planning and development of

FOXTROT, Dean fi elded countless capability requests which

often included developing off hours as our PI’s imminent

deployment and demanding requirements required full

time attention. Ultimately, the FOXTROT application and

portal received accolades from numerous users and remains a

capability with growing enhancements being evaluated to serve

our medic warriors.

Dean is an incredibly dedicated, hard worker, and loves to

solve complicated problems that meet the needs of our military

heath care teams and their specifi c problem set. We have yet to

send him a challenge he has not met and remains well worthy of

this nomination! Congratulations Dean and please keep up the

amazing work!

Mr. Ronnie “Dean” Parrish, is mHIC’s Q1 Employee of the Quarter.



10

TATRC Visits UK’s Ministry of Defense to Establish a Collaborative Research Partnership

Last fall, TATRC personnel packed

up and headed off to visit the United

Kingdom’s Ministry of Defense (MOD)

Surgeon’s Offi ce to collaborate with the

United Kingdom’s military telemedicine

lead, Lt Col Oliver Bartels. Mr. James

Beach, Project Manager from TATRC’s

Medical Intelligent Systems Lab traveled

as part of a multi-Service delegation,

along with Dr. Greg Burnett from the U.S.

Air Force Research Laboratory (AFRL)

and Mr. Jeff Luciano from the Program

Management Offi ce, Special Operations

Forces Support Survival Equipment

Systems. Over the course of four days

hosted at the MOD’s main building

and the HMS President in London, the

group met with 46 MOD personnel

to conduct capability demonstrations

with the Battlefi eld Assisted Trauma

Distributed Observation Kit

(BATDOK™), and to discuss TATRC’s

research roadmap for Virtual Health.

Th e British participants were medics,

physicians, regimental surgeons, military

exercise planners, capability developers,

and acquisition personnel from across the

three single Services (British Army, Royal

Navy and Royal Air Force) and Joint

Forces Command.

Lt Col Bartels conducted various

briefi ngs about the United Kingdom’s

telemedicine development activity

(Project LARA) that he leads as a military

anesthesiologist with extensive operational

experience. His team is already integrating

several capabilities including the Tempus

Pro Physiological Status monitor that is

commonly found in the Tactical Combat

Casualty Care kits provided to U.S. Special

Forces Organizations. Th rough Project

LARA, Lt Col Bartels has demonstrated

telemedicine capabilities and is actively

pursuing research eff orts that are similar

to the USAMRDC research eff orts led

by TATRC. Th ese briefi ngs served as

Group Photo from the HMS President on the Thames River with the Tower Bridge in the background. Personnel from left to right are: 2LT Matt Dickinson, Mr. James Beach, Lt Col Bartels, Dr. Gregory Burnett, Mr. Jeff Luciano, and 2LT Corey Mack.

an introduction to each group for MOD

telemedicine research and development

eff orts for both UK and U.S. personnel.

Dr. Burnett, along with 2LT Corey

Mack and 2LT Matt Dickinson, conducted

multiple BATDOK demonstrations that

included hands-on practicums to allow

for the MOD personnel to evaluate the

BATDOK capability for potential use

within the United Kingdom’s Armed

Services. Th e UK personnel were able

to become extremely familiar with the

BATDOK capabilities for local patient

monitoring and documentation for pre-

hospital care. Dr. Burnett also discussed

how the capability could easily be adapted

to address specifi c UK pre-hospital medical

documentation requirements.

Mr. James Beach briefed on current

TATRC Virtual Health research

and the Virtual Health Roadmap

and discussed potential collaborative

research opportunities for telemedicine

interoperability between the United

Kingdom and United States at each

session involving key United Kingdom

capability development and acquisition

personnel. Th is TATRC briefi ng discussed

the transformation of BATDOK into a

fully-fl edged pre-hospital telemedicine

system in partnership with Dr. Burnett

and Mr. Jonnie Johnson at the Combat

Capability Development Center Aviation

Missile Center through the Joint Program

Committee-One funded Medical Data

Cloud research. Th e linkage of this research

and resultant data collection capabilities

for the Clinical Decision Support Systems

(CDSS) and Artifi cial Intelligence (AI)

development was also discussed to introduce

U.S. Military concepts for CDSS and AI

Virtual Health Systems. Th e mechanisms

to collect suffi cient proper clinical data

to inform the development of CDSS and

AI systems do not currently exist. Mr.

James Beach also provided information

TATRC in UKcontinued to page 11



11

Director’s Town Hall Focuses on New Lab Space and ‘Rallies the Troops’ for the Year Ahead!

on how this research will further progress

into robotic and autonomous systems to

augment medics on the ground to reduce

the reliance of communications.

Lt Col Bartels stated, “It was a pleasure

to host this visit to the United Kingdom by

fi ve colleagues from across the U.S. Armed

Forces. Th e opportunity to meet and discuss

virtual health and digital pre-hospital

patient management systems, with a view to

future collaboration was incredibly useful.

Th e visit allowed the teams from AFRL,

TATRC and SOCOM to brief 46 UK

MOD personnel over three days on their

programmes of work to help shape the UK’s

understanding of which telemedicine and

virtual health technologies we will need

going forward to achieve interoperability.

A great visit in all respects and we are

looking forward to building on these

relationships formed.”

As a result of this visit, the UK

telemedicine lead and TATRC are

staffi ng a draft Cooperative Research and

Development Agreement (CRADA)

focusing on how information systems and

virtual health can support interoperability.

Research opportunities will focus on

more than technology integration. For

telemedicine interoperability, larger issues

revolve around diff erences in partner nation

clinical practices, combat medic scope of

practice, human-to-human communications,

and medical record legislation for

provisioning of care in a multi-national

environment. Th e CRADA will focus on

using current prototypes in research and

in advanced development to demonstrate

technology interoperability. In addition,

the cooperative research relationships

established off er enhanced technology

surveillance capability for Virtual Health

technologies that covers both sides of

the Atlantic Ocean. Th rough proper

coordination and collaboration, the

United Kingdom and United States

will be able to demonstrate options to

clinically support each other in multi-

national operations, even in cases where

there is no appetite to put boots on the

ground for mutual support.

TATRC in UK continued from page 10

Last December, Team TATRC had the

opportunity to assemble in what is soon

to become TATRC’s *NEW* Technology

Comparative Eff ectiveness Lab for the latest

Quarterly Director’s Town Hall meeting!

A lot of hard work has been done and

progress is being made for the future of

our organization, and with progress comes

change! Th e Town Hall provided an excellent

opportunity for TATRC’s Director, COL

Jeremy Pamplin, to bring the team up to

speed on the latest organizational happenings

and to highlight the recent achievements.

Th e meeting opened with a special

addition to the agenda, as COL Pamplin

presented Dr. Loretta Schlachta-Fairchild,

who served as Coordinator of Medical

Simulation and Information Sciences

(MSIS) at Joint Program Committee-1

( JPC-1), and who retired at the end of

2019, with a special Director’s Coin for

all the dedicated work and remarkable

achievements she’s accomplished

throughout her career in support of

advancing Military Medicine in support of

the Warfi ghter!

Th e focus then shifted back to

TATRC-related business, where we

were able to cover quite a lot of ground,

including a look back at what has been a

very dynamic and metamorphic year for the

organization, to include our new mission,

our organizational restructuring, rebranding

and strategic messaging, as well as an

optimistic look at the road ahead and our

goals for 2020!

As COL Pamplin stated, “We are in

a good position, not only to exist, but to

start to expand.”

Th anks to the hard work being put

in across the board, by our entire staff

and leadership, as we are poised to grow

and become more eff ective and impactful

than ever in this new age of military

medical technology!

COL Pamplin addresses the Team in the new Technology Comparative Eff ectiveness Lab during the organization Town Hall this past December.

Director, COL Jeremy Pamplin, congratulates Dr. Loretta Schlachta-Fairchild on a long and successful career in support of Military Medicine and presents her with the Director’s Coin.



12

downrange retinal imaging camera

capabilities were also discussed for

FOXTROT integration, allowing greater

remote diagnostic capabilities which still

meet the rigorous security and privacy

requirements of medical data exchange

which the MHCE provides.

MAJ William Gensheimer, Air

Force Ophthalmologist who deployed

FOXTROT in Bagram Airfi eld,

Afghanistan stated,”FOXTROT

introduces a powerful new tool for

decision support in operational

environments to diagnose military-

relevant eye disease, illness, or injury;

prescribe mitigation and treatment

strategies; and determine risk of

Warfi ghter’s return to duty. Th e ability

to provide virtual and remote eye care

and clinical decision support has never

been possible in battlefi eld medicine,

TATRC’s Mobile Health Project ‘FOXTROT’ Trots into the SpotlightOcular Expert Visits TATRC Fort Gordon Campus

Th e last week of September

brought a welcome visit to the Mobile

Health Innovation Center’s (mHIC)

Ft. Gordon team as LTC Jennifer

Stowe visited for two full days of

collaboration and further project

planning for the highly acclaimed

Forward Operating Base EXpert

Telemedicine Resource Utilizing

MObile Application for Trauma

(FOXTROT) project.

Project FOXTROT is a secure

tele-ophthalmology mobile app for

treatment of ocular trauma utilizing

the Mobile Health Care Environment

(MHCE) system, and this solution

provides a novel approach for creating a

training platform for medical providers,

specifi cally with regard to ocular

trauma care.

LTC Stowe, Deputy Director of

Injury Protection and Biodynamics,

as well as Science Program

Administrator from the U.S. Army

Aeromedical Research Laboratory

(USAARL), served as the Co-

PI on Project FOXTROT and

worked directly with the mHIC

Developers to discuss enhancements

of the existing FOXTROT platform

capabilities, including the integration

of a tonography tool, which

records intraocular pressure, within

FOXTROT. LTC Stowe briefed

the team on the clinical utility of

downrange tonography in that it is the

more drastic changes in intra ocular

pressure, rather than a steady, high

pressure which are more damaging to

the optic nerve. Further explaining that

a large percentage of TBI and or blast

patients go on to develop glaucoma

and other IOP diseases. Enhanced

and represents a unique, specialized-care

capability gap that is capable of aff ecting

all service members.”

Th e visit concluded with fi nalizing

the storyboarding for integrating the

Apple Watch capability with the mCare

app, as an option for users who are

recording their activity on projects such

as DREAM and future readiness use

cases for mCare/MHCE. LTC Stowe

was recently assigned a new research role

at Ft. Rucker, AL, and suggested there

are many collaboration opportunities

for TATRC and the USAARL,

and recommended TATRC send

representatives to tour and visit her new

stomping grounds soon.

Operational view of Project ‘FOXTROT’ (Forward Operating Base EXpert Telemedicine Resource Utilizing MObile Application for Trauma).

FOXTROT into Spotlight continued to page 13


TATRC TIMES

13


National Guard Announces Proof-of-Concept Pilot of TATRC Readiness App

Over the past 2 years, the Army National Guard (ARNG)

and TATRC’s Mobile Health Innovation Center

(mHIC) have been working collaboratively on a medical

readiness app called ‘PR2ME’ (Portal for Ready and Resilient

Individuals Using Mobile Enterprise). PR2ME, a component

of the Mobile Health Care Environment (MHCE) system,

is a novel and secure mobile application that ARNG citizen-

soldiers can use on their personal devices to complete the DoD

Periodic Health Assessment (PHA), Part A. On Saturday,

November 16th during a quarterly ARNG Medical Advisory

Group (MedAG), mHIC Deputy, Ron Yeaw, performed

a capabilities brief and live, interactive demonstration of

PR2ME. Th e MedAG had State Surgeon representation from

all 54 ARNG states and territories. In attendance was, among

others, BG Stewart Reece, the Deputy Commander 35th

Infantry Division, and BG Jill Ferris, the National Guard

Deputy Surgeon General. Th e goal was to get consensus to

transition PR2ME research to a limited fi eld testing trial with

the Maryland Army National Guard (MD-ARNG).

Following the live demonstration, LTC Tim Cho, Chief of

Preventive Medicine, ARNG, gave his support for the product

to begin live patient fi eld testing. Th e ARNG MedAG was

excited with the demonstration and collectively approved the

March 2020 proof-of-concept pilot of PR2ME. Per LTC Cho,

“Th e initial operating capability (IOC) is ready to be tested

and I am glad that the MD-ARNG will be able to conduct a

proof of concept starting next year.”

MD-ARNG Deputy State Surgeon, LTC Bill Fox stated,

TATRC mHIC Deputy, Ron Yeaw, pictured with LTC Tim Cho, Chief of Preventive Medicine, ARNG on the right and MD-ARNG Deputy State Surgeon, LTC Bill Fox on the left, among others, at a PR2ME kick off with the Maryland National Guard Medical Offi ce.

“MD-ARNG is very excited, and pleased to have been

selected as the IOC site for PR2ME and is ready to start

as soon as possible. Th e MD-ARNG is patiently awaiting

the opportunity to fi eld the PHA Mobile Application. All

indicators suggest the Mobile PHA will be a great resource

for Soldiers and Commanders, enhancing nationwide

medical readiness and overcoming some existing barriers

to completing Part A of the PHA by Reserve Component

Soldiers outside of the armory.”

Th ree additional proof-of-concept fi eld tests will be

performed in FY20, with the goal of an enterprise release

in the 1st quarter of FY21. With ARNG 350,000 citizen

soldiers, the PR2ME product has the potential to be

TATRC’s largest ever software fi elding to date.

FOXTROT Awarded 2019 AMSO ‘Project of the Year’In the fall, the Army Modeling and Simulation (AMSO)

Offi ce released their call for Fiscal Year 2019 nominations

for their annual Army Modeling and Simulation (M&S)

awards. Th e theme for FY19 was “Enabling Army Readiness

and Modernization” and there were 7 specifi c categories under

which M&S awards could be submitted.

LTC Jennifer Stowe, Co-Principal investigator on the

Project FOXTROT teleophthalmology mApp submitted a

FOXTROT into Spotlight continued from page 12

team nomination on behalf of the entire group of clinicians

and the TATRC Mobile Health Innovation Center Staff .

On December 17th, the AMSO notifi ed the mHIC staff

that they were the recipients of the 2019 AMSO Project of

the Year. Th e TATRC team members that were specifi cally

named for their contributions on this award are as follows:

Jeanette Little, Mabel Cooper, Ronnie “Dean” Parrish,

Amanda Schmeltz, Yukia Green-Matkins and Tabitha

Waldrop.



14

Congratulations to MISL’s Rebecca Lee on Employee of the Quarter!

Ms. Rebecca Lee of TATRC’s Medical Intelligent Systems Lab is the Q1 Employee of the Quarter

at TATRC HQ for continuing her outstanding work and untiring eff orts as a Medical Robotic & Autonomous Systems (MED-RAS) Research Projects Biomedical Engineer. Ms. Lee represents the future of Army medical technology research and engineering. She aggressively and enthusiastically takes on and promptly completes any program management task, whether it involves science and engineering or administrative, managerial or training tasks.

During Q1, while serving as a PI for a challenging two-phase Combat Medic Decision Support System research project, she planned, proposed, and initiated research under both DHP and Army S&T funding

programs, both of which required her to coordinate development of Transition Agreements with separate Program Managers within both the Army and the Joint community. For one of those which was accepted for funding, the TRUMAN Data Commons project, she volunteered to serve as the Contracting Offi cers Representative (COR). In this capacity, she organized and oversaw contractor conducted interviews and the collection of end user data requirements during the MHSRS meeting in Florida. This was highly successful with over 30 participants from both conventional and special operations military research, and operational communities having been interviewed.

Additionally, she has become a key participant in another MHSRS research collaboration meeting lead by the U.S. Army Institute of Surgical Research, for a project aimed at data collection and analysis for SEPSIS assessment and treatment in the fi eld. She submitted and participated in four new major research proposals involving biomedical engineering and/or medical intelligent systems and authored an MHSRS poster, as well as and an oral presentation and a conference proceedings paper for Association for Unmanned Vehicle Systems International.

To support and extend her own research and to help close unfunded technical gaps, she authored and continues to serve as COR for seven SBIR projects which leverage and further develop emergent enabling technologies from outside DoD. In most cases, her research eff orts involve signifi cant coordination and collaboration with numerous military labs, academic institutions, and private industry partners. In every case, she meets reporting requirements and maintains project performance, budget and schedule on track. Additionally, she took on numerous taskers in support of the MED-RAS Capability Area Manager for POM development and strategic planning, and promptly produced detailed model results.

An aspiring future technology leader, she served as a liaison for developing relationships with the Joint AI Center and completed the didactic portion of her Master’s degree program in Systems Engineering.

Congratulations, Ms. Lee on this high honor!

Employee SpotlightEmployee Spotlight

Ms. Rebecca Lee, Project Manager/Biomedical Engineer for Medical Intelligent Systems Lab.



15

New Project Offi cer to Join TATRC’s Medical Modeling and Simulation Team

Ms. Deborah Locke, Project Offi cer for Medical Modeling, Simulation and Visualization Lab.

For more information on TATRC and its many initiatives, visit: www.tatrc.org

or call 301.619.7927

FFo

Let’s Get Social!

Don’t Miss an Issue! Sign up and get the TATRC Times every Quarter!

To Subscribe and be added to our mailing list, please e-mail Lori DeBernardis at: [email protected]

Ms. Deborah “Debbie” Locke is the newest addition to join the

TATRC team. She will be supporting and assisting the Medical Modeling, Simulation and Visualization lab at TATRC headquarters at Ft. Detrick. In the role of Project Offi cer, she will provide assistance to the PI on various research projects as well as update project records,

track deliverables, compile data and information useful for medical research proposal documents and other areas of project planning.

A graduate of Virginia Commonwealth University, Ms. Locke has six years of project management expertise working exclusively on government contracts. In her previous roles, she was responsible for monitoring compliance, project scope, timelines, fi nancial forecasts, and resource management from project initiation to contract closeout. She managed performance on contracts that provided support for clinical trial research in the therapeutic areas of infectious disease, TBI, experimental therapeutics, sleep, human subject’s protection, medical devices, clinical monitoring, and regulatory aff airs. She was the primary contact for military and government customers at Walter Reed Army Institute of Research as well as Ft. Detrick.

Prior to government contracting Ms. Locke spent several years serving as a Payroll Tax Manager for a local

Defense organization and also large Hospitality company. She wrote policies and procedures for continuity of payroll tax practices and to improve effi ciencies.

Ms. Locke, a native of Baltimore, currently resides in Frederick, MD with her husband Mike. Both car enthusiasts, they belong to the Golden Gears Car Club of Frederick County. The club is dedicated to the preservation, use and enjoyment of classic, muscle and special interest vehicles. The club hosts benefi t events for charitable organizations in the community. They recently fi nished collecting two trailer loads of items for the local Toys for Tots Campaign. In addition to the car shows and cruise-ins, Ms. Locke spends a lot of time and energy training their brand new Yorkie puppy named Kasey.

TATRC is so happy to have this wonderful asset here to assist this up and coming lab!



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mailto:[email protected]



16

Dengue fever is a mosquito-borne

illness that is endemic to large

parts of South America, Africa, and

Asia, and is continuing to spread, along

with related viruses such as yellow fever

and Zika virus, due to climate change.

Localized outbreaks of dengue fever

can have a crippling impact on Force

Readiness, and the U.S. Army has long

prioritized the development of vaccines

or therapeutics that can protect Service

Members stationed in regions of the

world where dengue is endemic.

BHSAI Uses Simulations to Identify the Molecular Basis of Antibody Neutralization in Dengue Virus

Atomic model of a partially mature dengue virus particle interacting with a type-specifi c (blue) and a cross-reactive (pink) antibody shown using a surface representation. The mature (smooth) regions of the virus are shown at left, whereas the immature (rough) portion is located towards the lower right. The small, blue and pink spheres indicate the location of epitopes targeted by the type-specifi c and cross-reactive antibodies.

Dengue virus exists as one of four

types, or serotypes, that co-circulate

in the same geographical region. A

defi ning feature of the virus is that

while exposure to one serotype induces

lifelong immunity to that serotype,

that same immunity actually increases

the likelihood of severe dengue disease

following subsequent exposure to

one of the other three serotypes. In a

process known as antibody-dependent

enhancement of infection, or ADE,

antibodies induced by the earlier

dengue infection enhance the severity

of a subsequent infection. Researchers

have investigated ADE for years

in experimental settings, and more

recently in clinical studies on dengue

pathogenesis. However, the relevance of

ADE to dengue vaccine research was

unknown until the stunning fi nding in

a recent Phase 4 study of Dengvaxia,

a dengue vaccine produced by Sanofi -

Pasteur Inc., where some vaccine

recipients showed higher rates of severe

dengue disease following vaccination

than subjects who had not received the

vaccine, suggesting that the vaccine may

be triggering the ADE process.

Why do some antibodies neutralize

dengue virus whereas others enhance

infection? To answer this question,

researchers at TATRC’s Biotechnology

High Performance Computing Software

Applications Institute (BHSAI) turned

to molecular simulations guided by

in vitro data to provide insight into

virus neutralization and enhancement.

By modeling antibodies that are well

characterized in vitro, Dr. Daniel Ripoll,

a research scientist at the BHSAI, was

able to show how some mixtures of

antibodies neutralize dengue virus with

varying effi cacy while others enhance

infection. “Our simulations show that

ADE is dependent on the epitope

specifi city of the antibody response,”

explained Dr. Ripoll. “Some antibody

mixtures target predominantly cross-

reactive, poorly neutralizing epitopes

and lead to ADE under a wide range of

conditions.” Th e simulations reveal that

antibodies typically found following

secondary infections have a much higher

propensity for ADE than those produced

in response to the initial infection,

providing a molecular basis for enhanced

risk of severe dengue disease. Dr. Ripoll’s

Dengue Viruscontinued to page 17


TATRC TIMES

17


This fi scal year is the second year that the newly established Virtual Health (VH) Research Task Area is

able to support research proposals with Army S&T funding. Th e focus of this research is to support the medical needs of the far-forward Multi-Domain Battlefi eld. Considerations for virtual health to support in prolonged fi eld care scenarios and limited and/or non-existent communications due to electronic warfare, are key aspects of this research funding.

Th is exciting new research area falls under the Army

Medical Simulation and Information Sciences (MSIS)

Research Program portfolio. Th e nature of this research is

Army 6.2 funding, that is applied research, which is defi ned

as “systematic study to gain knowledge or understanding

necessary to determine the means by which a recognized and

specifi c need may be met.” Ms. Jeanette Little, who is Lab

Director of TATRC’s Mobile Health Innovation Center,

also serves as the Capability Area Manager (CAM) for

the new Virtual Health Research Task Area and is excited

about the foundational work these intramural / extramural

eff orts will provide to the research portfolio. “Th e second

year of Virtual Health research projects were vetted by an

external peer review team and an internal Virtual Health

Steering committee prior to being selected for funding. All

of the projects focus on identifying common ground with

other government, academic and industrial research eff orts,

modeling and visualizing the future multi-domain needs,

ensuring that semi-autonomous patient monitoring considers

the consequences of cyber vulnerabilities and electronic

warfare, and how virtual reality can augment care,” said Ms.

Jeanette Little.

In FY20, the MSIS Medical Assisted Support

Technology (MAST) Virtual Health Research Area will

support both intramural and extramural research eff orts.

Two of the key intramural eff orts that will be funded under

the Virtual Health research portfolio are continuations of

projects that commenced in FY19. Th e fi rst project is, the

“Use of Augmented Reality Concepts to Deliver Critical

Care in a Prolonged Field Care Environment.” Th e Principal

Investigator is Maria Serio-Melvin, MSN, RN from the

U.S. Army Institute of Surgical Research. Th e second project

entitled: “Emerging Cybersecurity and Communication

Solutions to Achieve Remote, Semi-Autonomous Patient

Monitoring Systems (PMS) in the Future Battlespace” is

led by Principal Investigator, Mr. Ron Yeaw, from TATRC,

and the Co-Investigator Eddie Eidson from Army Futures

Command’s Cyber Battle Lab.

In addition to these ongoing research eff orts, there will

be two new intramural projects starting up in FY20. Th ey

are “Optimization and Automation of Virtual Health Data

Capture, Prioritization and Communication to Improve

Casualty Care” with Mr. Geoff Miller from TATRC serving

as the Principal Investigator and “Vocal Behavioral Markers

of Stress Response: Developing an Empirical Framework

for Non-invasive Machine-Learning-Based Health Risk

Indicator” with Principal Investigator Phillip J. Quartana,

Ph.D. from Walter Reed Army Institute of Research.

Finally, it is anticipated that there will be 2 extramural

research awards in FY20, however, these eff orts have not yet

been awarded, and therefore cannot yet be announced. Please

stay tuned as there is much more to follow in this exciting

new research area!

MAST Virtual Health FY20 Update

fi ndings were recently published in the journal, Frontiers in

Cellular Infection Microbiology.

BHSAI’s research eff orts into dengue vaccines continues in

FY20, in the form of collaboration with Dr. Adam Waickman

and Dr. Heather Friberg-Robertson at the Walter Reed Army

Institute of Research. Th ere, BHSAI scientists will apply

sequencing, modeling, and simulation methods to analyze

Dengue Virus continued from page 16immune responses from two Army dengue vaccine candidates:

the Purifi ed Inactivated Virus and the Live-Attenuated Virus.

Dr. Sid Chaudhury from the BHSAI stated, “By combining

extensive profi ling of the immune responses from clinical studies

with computational modeling, we aim to understand exactly

what immune responses are being elicited by these vaccines and

how they contribute to protection.”

Use of Augmented Reality Concepts to Deliver Critical Care in Prolonged Field Care Environment is one of the key intramural eff ort that will be funded unde the Virtual Health research portfolio.



18

TATRC’s Medical Modeling

Simulation, Informatics and

Visualization (MMSIV) team recently

completed the development of the new

Joint Medical Simulation Instructional

Methods ( JMedSIM) portal. Th e

portal, developed in consultation with

the Defense Health Agency (DHA)

J7, will provide knowledge, skills and

confi dence while using simulators for

simulation training scenarios. Sites

identifi ed that they needed a way to

consistently and continuously train new

personnel on a variety of simulators

and training practices, because in this

environment of cost constraints, a

means of training without the cost of

TDY has become essential. TATRC

has initiated and developed a solution.

Over the past 12 months, TATRC

staff worked with key medical

simulation leaders from centers across

all 3 services to develop a robust and

comprehensive repository of content

and training tools to identify the

foundations of a simulation training

curriculum as well as a wealth of

materials to train simulation operators.

Th is supported the objectives identifi ed

at the beginning of this initiative which

were twofold:

First was to improve simulation-

based medical education and

assessment across the Military

Health Service (MHS) through the

development of a standardized, blended

learning JMedSIM curriculum.

And second, was to develop a

common standard JMedSIM Portal

to collect, describe, catalogue, curate

and distribute instructor and operator

resources and simulation materials.

Th e repository has been populated

with thousands of various images and

videos that were collected over the

course of this initiative from multiple

simulation centers throughout CONUS.

Not only have the images and videos

been cataloged for use within the courses

developed, but the materials have also

been tagged with metadata, to make

them readily available for inclusion in

training materials.

Ruben Garza, Director, Modeling

and Simulation Offi ce, J7, is excited

to make this tool available soon to all

simulation centers throughout the DHA.

Mr. Geoff Miller, Lab Lead for the

MMSIV stated, “Th e main goal of any

training program is to prepare trainees

to perform eff ectively on post-training

tasks in a real-world setting. Th is goal

equally applies to medical and healthcare

educators and simulation specialists.

Th e effi cacy of healthcare simulation

activities for learners depends on the

knowledge and skill of the instructor

and the simulation operations specialist.

Most instructors / operators have

on the job training and a few have

attended civilian course in healthcare

simulation. Th is project will produce a

series of simulation instructor / operator

The team from U.S. Air Force School of Aerospace Medicine at Wright Patterson Air Force Base in Dayton, Ohio simulated C-17 loading and unloading procedures as Team TATRC captures and documents the demonstration.

MMSIV’s New Joint Medical Simulation Instructional Methods (JMedSIM) portal

JMedSIM continued to page 19



19

Team TATRC keeps the holiday spirit going strong! Last December

marked the 24th year for our Annual Holiday Party! More than 60+

staff , alumni, and family all gathered to enjoy this festive annual event which

featured some fun, holiday-spirited games and team-building exercises, as well

as the ever so popular and infamous Year in Review slideshow that always

captures the true spirit of the TATRC family and highlights the fun and

accomplishments from the past year! Th is year also debuted a new tradition

in the form of an opening poem from TATRC’s newest Deputy Director and

“Dabbler in Doggerel,” LTC (P) Justin Stewart, that Shakespeare himself

would’ve been proud of. Director and “Commander in Cheer,” COL Jeremy

Pamplin closed the event with a rousing, heartfelt look back at this past

year, and an enthusiastic look at what lies ahead for our organization! A very

special thank you to all who attended and made the event a success yet again,

and here’s to next year!

TATRC’s Public Aff airs and Multimedia team were key and instrumental in traveling to the numerous sites to collect and capture all the content from across multiple simulation labs in the country.

Director and “Holiday Head Honcho,” COL Jeremy Pamplin, spreads good tidings to the team.

As always, this year’s event enjoyed a great turnout.

professional development courses that

can be delivered to military personnel

who are responsible for the conduct of

simulation based medical / healthcare

education.”

Team TATRC wishes to gratefully

acknowledge and thank the following

Sim Centers for their unwavering

support, gracious hospitality and

unlimited access to their facilities.

Without their support, none of this

would be possible.

A Shout out to: Th e Uniformed

Services University of the Health

Sciences & the Val G. Henning

Simulation Center in Bethesda, MD,

Th e Medical Readiness Training Center

at Camp Bullis, Th e Defense Medical

Readiness Training Institute at Camp

Bullis, Wilford Hall Ambulatory

Services Center Sim Center at JBSA,

Lackland, METC Department of

Combat Medic Training, and the team

at JBSA running the Tactical Combat

Medical Care Course, Th e 711 Human

Performance Wing - US Air Force

School of Aerospace Medicine at Wright

Patterson Air Force Base in Dayton,

Ohio, and Th e Naval Medical Center in

Portsmouth, VA.

Another Year of Holiday CheerJMedSIM continued from page 18


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AMTI Shines A Spotlight on Warfi ghter Performance

PRO J E CT S POTL I GHT

Health care costs for running

related musculoskeletal injury

in the AMEDD exceed $560 million

annually. Th e majority of these injuries

are overuse in nature. TATRC’s

AMTI program funded a project to

further research these injuries called

the “Feasibility of Wearable Devices

to Measure and Monitor Changes in

Gait Characteristics during Running”.

Ms. Holly Pavliscsak, AMTI’s

Program Manager stated, “Th is project

highlights the AMTI programs’

continued support of projects that

reinforce TATRC’s overall mission to

fuse data, humans, and machines into

solutions that optimize warfi ghter

performance and casualty care.”

Seventy-fi ve to ninety percent of all

runners demonstrate a rear foot striking

(RFS) gait pattern, which produces

increased average vertical loading rate

(AVLR), impulse, peak impact forces,

and vertical ground reaction forces

(vGRF). Th ese same kinetic forces are

implicated in overuse running injuries.

A non-rear foot striking (NRFS) gait

pattern has consistently been shown to

reduce AVLR, impulse, and vGRF as

well as completely eliminate the impact

peak seen in RFS runners. Logically,

this suggests that transitioning from a

RFS gait pattern to a NRFS gait pattern

would reduce injury and injury risk

in runners. Unfortunately, the current

standard of practice is symptomatic

treatment with little attention to

underlying biomechanical and motor

control abnormalities. Th is occurs largely

because of clinical time constraints

and the cost of specialized equipment

needed to perform these types of

analysis. Transitioning patients to a new

foot strike pattern who have already

sustained an injury associated with a

RFS pattern would provide a modest

cost savings to the military health care

system in preventing recurrent injury.

However, transitioning individuals with

an RFS pattern to a NRFS pattern

across the enterprise to prevent injuries

could result in cost savings of tens of

millions of dollars annually. To realize

this vision with respect to running

patterns, appropriate monitoring and

guidance needs to be applied as a new

motor pattern is learned in order to

prevent secondary injury. Coupling the

power of wearable technologies with

evolving analysis strategies may provide

clinicians with a user-friendly platform

to develop meaningful re-education

Cross-sectional view of how strike pattern data was captured in the study.


TATRC TIMES

21


programs to drive motor learning that

can be implemented as a preventative

health measure across a larger cross-

section of an at risk population (e.g.

Soldiers who run) with a modest

investment of clinical resources. Recent

advances in pressure sensing insoles and

body worn sensors (accelerometers and

gyroscopes) are an appealing option to

provide this level of monitoring and

have the potential to infl uence both

immediate user (runner) feedback and

clinician-based program development.

Th is technology demonstration

evaluated the eff ectiveness of a program

designed to transition runners with a

RFS pattern to a NRFS pattern in both

a laboratory setting and during over-

ground running.

Findings from the initial project

yielded several promising results. Th e

AMTI awardees found that by using

a short term, group-based training

program, AVLR was successfully reduced

in habitual RFS runners to NRFS runner

levels and maintained over 3 months

without structured follow up. Th erefore,

group-based training programs with

minimal instrumentation can produce

robust changes in running parameters

known to be associated with higher

injury risk. Given the operational

tempo of units and the frequency of

military deployments and personnel

turnover, it is important that programs

targeting motor control changes be

robust and effi cient. Th e three week

training program designed in this

technology demonstration appear to have

promise in implementing such changes.

Such interventions may be eff ective

components of injury reduction strategies

in military settings. Future investigations

will need to assess how these types of

training programs can be adapted to

optimize change across participants.

Th e team further demonstrated

that wearable technologies

demonstrate good to excellent

correlation with robust laboratory

measurement systems in characterizing

Collated strike pattern data results extracted using the AVLR device.

specifi c temporal and spatial running

gait parameters. Th ese results would

suggest that such technologies may

serve as acceptable surrogates to

laboratory-based assessments, which

is a necessary step to implementing

unit-level injury prevention initiatives.

Future projects need to determine

what spatio-temporal parameters

have the best predictive injury risk

reduction capacity and whether these

parameters can be optimally measured

and assessed for changes associated

with training programs.

Unfortunately, none of the

evaluated wearable technologies

provided a turnkey solution to reduction

and processing of a comprehensive

running gait assessment. “It is

obvious from this investigation that

there is a need for a wearable sensor

suite, supported by a robust and

comprehensive software platform, that

can provide the average clinician with

the means to accurately and reliably

measure meaningful gait data that will

facilitate the clinician’s ability to assess

impairments and develop personalized

training programs to reduce injury risk,

optimize recovery and prevent re-

injury,” stated LTC Angela Diebal-Lee,

PI for this project and Director, Physical

Performance Service Line General

Leonard Wood Army Community

Hospital. Future eff orts need to be

undertaken to realize this objective in

order to optimize care of Warfi ghters

and other DoD benefi ciaries.

MAJ Mark Lester, Director Center

for Rehabilitation Science, Associate

Professor Army-Baylor University

Doctoral Program in Physical Th erapy

said, “Running injuries are a major

burden on the military healthcare

system and currently there is a lack of

evidence regarding running training

programs that may reduce injury

susceptibility in military settings. Th is

work is encouraging as it demonstrates

the potential to off er an eff ective group

based running instruction program

which could be eff ective at reducing

musculoskeletal injuries and increasing

the readiness of the force. Injuries are

extremely costly and this initiative is an

eff ort to promote a system of health in

an extremely active population.”


TATRC TIMES

22

July 2020 • Volume 6, Qtr. 1 TATRC TIMES

2222


Virtual Reality Trauma Simulation: An Immersive Method to Enhance Military Medical Personal Training and Readiness

PRO J E CT S POTL I GHT

Two years ago, Madigan Army Medical Center’s

(MAMC) Emergency Medicine Research

Department initiated a project to create a realistic

trauma simulator in immersive virtual reality (IVR).

Similar to a pilot’s flight simulator, the Trauma

Simulator is a free-play virtual reality training platform

capable of training military medical personnel through

dynamic physiologic responsive simulations that

allow decision-training without an instructor. The

primary focus was on decision training (i.e., cueing)

when to initiate a blood transfusion, place a chest

tube, or complete a cricothyrotomy. IVR can be highly

effective as a medical simulation training platform.

Recent advancements have rendered this technology

increasingly portable and visually realistic. The system

leverages a highly-responsive, validated physiology

simulation (Biogears/Pulse Engine) funded by over

$7 million in prior DoD based research. Tying

interventions and visual output to the physiology

engine results in realistic alterations in levels of

consciousness and vital signs. It also allows injuries to

present and respond to treatment in real-time without

instructor input. This highly-responsive simulation,

combined with an environment containing 100+

3D objects to treat the patient (replicated from the

Madigan trauma bay), creates a highly interactive

and realistic experience. The system tracks when a

learner identifies an injury and their time to critical

interventions. Therefore, the user can practice and

receive feedback on advanced trauma life support

(ATLS) and tactical combat casualty care (TCCC)

repeatedly without an instructor being present. This

IVR system was designed as a scalable solution to

allow a wide variety of future case combinations and

incorporation into multiple treatment environments.

Figure 1: Army Medic looks at vital signs monitor in current simulator at a role 3 in Iraq (Feb, 2019).

VR Trauma Simulationcontinued to page 23


TATRC TIMES

23


Th e fi nal software version was

completed in March 2019, and

preliminary data from 10 board-

certifi ed emergency medicine

physicians indicates a high level of

visual, injury, and treatment realism.

Th e hardware required is a gaming

computer and a Microsoft Mixed

Reality headset. Th e complete

setup costs approximately $2000.

It can run without an internet

connection, and has been utilized

in a ROLE III deployed location

(tent structure) in Iraq with good

functionality (Figure 1).

The programming was

completed by Exonicus, Inc,

and Kitware, Inc assisted with

physiology engine integration.

Both of these vendors have

expressed interest in continuing

the progression of this project.

The team also had additional

support from Dr. Ryan Walsh from

Vanderbilt University and Dr.

Tam Pham from the University of

Washington. TATRC supported

this endeavor with funding from the

AMTI Program’s Rapid Innovation

Fund in the amount of $245,977.

CPT Kyle Couperus, the

PI of this project stated, “we are

incredibly happy with what we have

achieved as a result of TATRC’s

AMTI Program Funding, our team’s

hard work, and the vendor’s support.

We feel this technology shows

how autonomous virtual reality

simulation presents an achievable

solution that can improve military

medical training and readiness.”

This project has been presented

at multiple locations and venues,

including the Special Operations

Medical Scientific Assembly

(2019), Military Health Science

Research Symposium (2019),

American College of Emergency

Physicians Scientific Assembly

(2019), Joint Services Symposium

Emergency Medicine (2019), DHA

Strategic Simulation Summit

(2019), and three presentations

at the International Meeting on

Simulation in Healthcare (IMSH

2019) where it received the

prestigious SimVentor Award out

of 82 projects! Two manuscripts are

pending publication, and there is

ongoing research study recruitment

at MAMC.

3D scan of Madigan trauma bay for VR build.

View inside simulator during active resuscitation.

VR Trauma Simulationcontinued to page 24

VR Trauma Simulation continued from page 22


TATRC TIMES

24


CPT. Couperus has applied for

follow up funding and indicated the

project has several future goals. “We

propose expanding these virtual

environments to include multiple

echelons of care (ROLE I-III), and

medical evacuation platforms. The

rooms, equipment, and medical

supplies in the simulator will

correspond identically to real-world

locations. The experience will be

built around engaging simulations

requiring active decision making

to manage patients with the

top battlefield killers: airway

obstruction, tension pneumothorax,

and hemorrhage. A mass casualty

event with multiplayer functionality

will be integrated into the training

experience. We hypothesize that

training individuals in identical

virtual environments with

autonomous interactive trauma

scenarios will allow more rapid

assimilation to deployed treatment

environments, shorten the time to

life-saving interventions, decrease

the risk of psychological trauma,

and help maintain medical provider

readiness.” The team is very excited

to pursue these additional aims.

The project is under review by

the American College of Surgeons

Committee on Trauma, evaluating

the feasibility of incorporation into

Advanced Trauma Life Support

training. Additionally, the Madigan

team is actively communicating

with several research programs to

coordinate efforts and improve

future integration and scalability.

These include the University of

Washington Advanced Modular

Manikin/UWNEST programs,

University of North Carolina

& Biomojo, Biogears, IVIR,

Inc (POINTS/JETS), and the

University of Florida medical

simulation development team.

Overall, the scalability of this

solution has multiple civilian,

emergency medical services, and

Coalition partner evaluation (Latvian).

VR Trauma Simulation continued from page 23

international training implications.

CPT. Couperus stated in

closing, “We greatly appreciate

TATRC’s AMTI RIF funding

support that enabled this exciting

endeavor. This project has involved

a large team who all deserve

recognition for their original ideas

and innovative contributions. A big

thank you to MAJ Chad Gorbatkin,

CPT Zachary Sletten, LTC Scott

Young, CPT Alex Koo, CPT

Robyn Essendrop, CPT Matthew

Esposito, MAJ Jillian Phelps,

CPT Karl Kmiecik, LTC(P) Carl

Skinner, MAJ Jonathon Weyand,

COL Jason Bothwell, MAJ Kristin

Fiala, CPT Tony Hawkins, CPT

Nicholas Walthers, Dr. Christopher

Kang (MAMC), Dr. Ryan Walsh

(Vanderbilt), and Dr. Tam Pham

(University of Washington).

This project would not have

been achievable without such an

incredible team!”

Holly Pavliscsak, who serves as

TATRC’s AMTI Program Manager

stated, “The AMTI program

provides seed funding to projects

such as Virtual Reality Trauma

Simulation that allows enthusiastic

Innovators like CPT Kyle Couperus

to have the support to make their

great ideas come to life! The small

investment made in this important

project has produced multiple

publications and presentations

in the last year and has provided

the justification for expansion to

additional clinical applications and

formal research”.

Documents

TATRC TIMES · the work, and we need your partnership more than ever.” BG Talley specifi cally appreciated the vast cross-lab, academia, and industry partnerships and relationships